Abstract

Introduction and Aims

The emergence of novel psychoactive substances has been reported in clinical studies and recent studies of users. The use of these substances in European nightlife scenes is well documented. Little research has been done to identify the prevalence of these drugs among young adults active in other regions. We focus our sample on socially active young adults to gain an indication of the prevalence and understanding of demographic factors associated with past year mephedrone (‘meph’, ‘bath salts’) and synthetic cannabinoid (‘spice’, ‘K2’) use.

Design and Methods

This study reports on the results of a field-based survey of 1740 patrons at nightlife venues in New York City.

Results

Within the sample, 8.2% reported use of synthetic cannabinoids and 1.1% reported the use of mephedrone. Gay and bisexual men reported higher prevalence of mephedrone use. Latinos reported higher prevalence of synthetic cannabinoid use. Multivariate analyses indicate that sexual minority identity is associated with mephedrone use and younger age and Latino ethnicity are associated with synthetic cannabinoid use.

Discussion and Conclusion

The findings suggest that the use of synthetic cannabinoids and mephedrone among adults in US nightlife scenes remains relatively low in comparison with European nightlife scenes, and is low relative to other drug use among young people within these scenes. [Kelly BC, Wells BE, Pawson M, LeClair A, Parsons JT, Golub SA. Novel psychoactive drug use among younger adults involved in US nightlife scenes. Drug Alcohol Rev 2013;32:588–593]

Introduction

Novel psychoactive substances—referred to by some as ‘legal highs’ though they are increasingly controlled substances—have become a greater part of the drug landscape in recent years [1]. As a result, they present young people with additional options for drug consumption while also functioning within a legal grey area across jurisdictions and nations. Over the past decade, novel psychoactive drugs became increasingly available via ‘head shops’ and the Internet as producers aimed to take advantage of loopholes in controlled substance laws. During the last several years, mephedrone and synthetic cannabinoids have emerged in the latest wave of novel psychoactive drugs. Clinical case reports have provided information on these emerging trends [2-5], yet studies of non-clinical populations lag behind these focused investigations.

Mephedrone, also described as ‘bath salts’, ‘mcat’ or ‘meow-meow’, is a synthetic cathinone with stimulant properties that produce increased energy and euphoria. ‘Bath salts’ have been recently reported to contain a range of psychoactives, including, but not limited to, mephedrone. Other substances found in ‘bath salts’ include methylenedioxypyrovalerone, methylone, and fluoromethcathinone [5]. Mephedrone has come under increased scrutiny globally in recent years and has been rendered illegal in many nations recently, including in the USA via emergency scheduling by the federal government in 2011. An online survey of mephedrone users primarily living in Britain suggests that its formerly legal status and user comparisons to MDMA have led to an increase in its use in some regions, though these legal prohibitions also led some users to cease or reduce use [6]. In a qualitative study of mephedrone users in Northern Ireland, subjects reported positive experiences with the drug, yet indicated that its legal status did not imply complete safety for the substance [7]. Clinical studies have found a range of risks associated with the use of mephedrone and other synthetic cathinones, including agitation, tachycardia, hypertension, paranoia, confusion and aggression [5]. The epidemiology of mephedrone use is also developing. A study of mephedrone use among dance drug users in the UK suggests that users of this substance are likely to be younger and male [8]. Over 40% of these UK dance drug users reported the use of mephedrone [8]. Additionally, other research indicates that many users in the UK continued the use of mephedrone after its ban despite a subsequent price increase, suggesting that the substance may be becoming entrenched within a broader class of club drugs within some scenes [9]. It has been cited as popular in some European nightclubs, such as in London, even after its prohibition with prevalence in one sample of attendees of gay-friendly clubs at 41% [10].

Synthetic cannabinoids, often referred to as ‘spice’ or ‘K2’, mimic the effects of cannabis; their appeal is based on similarities to marijuana's effects. Like mephedrone, cannabinoids have become more of a focal point for global drug policy in recent years. While there is no federal legislation controlling the substance within the USA, synthetic cannabinoids are regulated at the state level, and became illegal in New York during 2012. Restrictions on these substances have recently emerged in other nations as well. Like mephedrone, relatively few non-clinical studies of synthetic cannabinoid users exist. A global survey of synthetic cannabinoid users indicated that many report significant positive effects with low levels of adverse effects [11]. Users in that sample also stated that the ability to use synthetic cannabinoids without triggering a positive drug test was a significant benefit. Australian users of synthetic cannabinoids have indicated that a range of side effects also exist, including irregular heartbeat, motor skill impairment, dizziness and paranoia [12]. Clinical studies also indicate risk potential for cardiac problems, seizures and psychosis [2]. Despite the quasi-legal status, there is evidence that the popularity of these substances lags behind that of marijuana. In a sample of US college students, lifetime ‘K2’ use was relatively low (8%) compared with typical estimates of marijuana use [13]. Younger college students and male students in this sample were more likely to report use of synthetic cannabinoids among this sample.

Current study

Though mephedrone and synthetic cannabinoids are among the latest substances to emerge in a growing range of novel psychoactive drugs, few studies of their prevalence exist. Given the rise of these novel psychoactive drugs, we assessed the prevalence of mephedrone and synthetic cannabinoid use among young adults involved in nightlife scenes in New York. Young adults involved in nightlife scenes are often forerunners of drug trends, and the use of a variety of other substances is quite prevalent in these scenes, including binge drinking [14], energy drink use [15], club drugs [16] and prescription drugs [17]. Assessments of this population may provide further evidence on how these drugs are situated among such young adults.

Methods

Sampling

We surveyed a sample of socially active young adults recruited from nightlife scenes from May to October 2012. The examination of socially active young adults allows us to concentrate our sampling methods on nightlife venues frequented by these populations. To generate the sample, we utilised time-space sampling, originally developed to capture hard-to-reach populations [18-20], but useful for generating estimates of venue-based populations as well [21]. Specifically, we utilise venues as the basic sampling unit to generate the sample of young adults in these nightlife scenes.

We captured a range of variability among socially active young adults through randomising: (i) the venues attended; and (ii) the days/times attending the venues. To construct the sampling frame of venues and times of operation, previous ethnographic fieldwork identified ‘socially viable’ venues in a range of nightlife scenes for each day of the week. A venue was deemed ‘socially viable’ if a threshold of young adult patron traffic existed on that day of the week. We generated lists of socially viable venues for each day of the week across several key scenes (e.g. gay clubs, lesbian parties, electronic dance music clubs, hip hop clubs and indie rock clubs). Each socially viable venue was listed and assigned a number. Using a random digit generator programme, a random number was drawn, corresponding to a particular venue on a particular day. This process yielded the recruitment schedule for each month.

Once at the venue, staff attempted to survey as many individuals as possible, aiming to achieve saturation at the venue. Staff surveyed participants both inside and outside of venues, typically dependent upon logistics (e.g. volume inside the club, staff restrictions). Each surveyor approached a potential subject, identified him or herself and requested verbal consent for participation in the anonymous brief survey. If the patron refused, this refusal was noted and staff estimated the individual's age, gender and ethnicity. For those who provided consent, staff administered the beginning of the survey (age, consent and residency) and subjects self-reported more sensitive information (such as race, sexual identity and drug use) directly onto survey software on an iPod Touch®. Staff members were trained to not administer surveys to individuals who were visibly impaired by intoxication. Though times ranged across venue hours, we attempted to avoid recruiting outside at the end of evenings (e.g. early morning) because this time period is when few individuals arrive and many leaving the venue are intoxicated with alcohol or other substances, which increases the likelihood of diminished capacity to consent.

Measures

Recruiters input respondent age to ensure age of consent. As is standard practice within the USA, participants first self-reported whether they identified as Latino, and then reported the racial group they most identified themselves with (White, Black, Asian, Native American, Multiracial or Other). Participants self-reported gender (female, male, transgender, or other—individuals identifying as transgender or other were excluded from these analyses because of small sample sizes); and self-reported sexual identity [straight, gay, lesbian, bisexual, queer or other—individuals identifying as ‘Other’ were excluded because of small sample size and sexual identity was recoded as either heterosexual or gay/lesbian/bisexual/queer (GLB)]. To assess past year drug use, participants were asked to report the number of days during the past year they had used ‘synthetic cannabis products such as Spice or ‘K2’ and ‘mephedrone, also known as meph or bath salts’. These permitted us to identify those who reported past year use of each of these drugs.

Data analysis

Prevalence estimates were computed using spss (IBM Corporation, Armonk, NY, USA). Chi-square analyses were conducted to examine differences in novel psychoactive drug use between demographic groups defined by gender, sexual identity and race/ethnicity. Stratified chi-square analyses were carried out to explore the effects of gender and sexual identity on novel psychoactive drug use, specifically exploring differences between gay/bisexual men, heterosexual men, lesbian/bisexual women and heterosexual women. To control for the competing effects of other variables, multivariate logistic regression analyses were conducted to evaluate the predictive nature of each of these factors on novel psychoactive drug use while controlling for the potentially confounding effects of other variables in the model.

Results

The sample consisted of 1740 younger adults ranging in age from 18 to 40. Their mean age was 26.4 (SD = 4.3). Slightly more than half were male (55.2%) and two-thirds (64.5%) of the sample identified as heterosexual, with the remainder (35.5%) identifying as GLB. A majority of the sample was White (60.5%), with 6.7% identifying as Black, 15.1% as Latino, 6.0% Asian or Pacific Islander, and the remainder (11.7%) identifying as of mixed or other racial origin. The use of both novel psychoactive substances was relatively uncommon within the sample, with 8.2% reporting the use of synthetic cannabinoids within the past year and 1.1% reporting the use of mephedrone within the past year. Among those who reported using synthetic cannabinoids or mephedrone, their average frequency of past year use was less than twice per month, 21.2 days and 17.5 days, respectively.

The data indicate a fair degree of consistency with respect to prevalence across gender and sexual identity. Through our stratified chi-square analyses, we found no statistically significant differences by gender/sexual identity group for synthetic cannabinoids and only a difference between gay/bisexual men and heterosexual women for mephedrone use (Table 1). Less than 10% of all groups reported any recent synthetic cannabinoid use and low levels of mephedrone use were reported across all groups. With respect to racial/ethnic differences in prevalence, Latinos reported higher prevalence of synthetic cannabinoid use in comparison with Asian/Pacific Islander respondents and respondents of mixed or other heritage. No racial/ethnic differences were found for mephedrone prevalence across groups. Additionally, analyses not presented here indicate that there were no significant differences in the use of these novel psychoactive substances between the types of nightlife scenes (Table 2).

All reported differences at P ≤ .05: aSignificantly different from heterosexual men. bSignificantly different from gay/bisexual men. cSignificantly different from heterosexual women. dSignificantly different from lesbian/bisexual women.

All reported differences at P ≤ 0.05: aSignificantly different from White. bSignificantly different from Black. cSignificantly different from Latino. dSignificantly different from Asian/Pacific Islander. eSignificantly different from Mixed/Other.

In a multivariate logistic regression analysis of the demographic predictors of synthetic cannabinoid use, we found no differences with respect to gender after controlling for other factors. Age was inversely associated with synthetic cannabinoid use (odds ratio = 0.92). In addition, Latinos reported higher odds of synthetic cannabinoid use relative to Whites (odds ratio = 1.62). No other racial/ethnic differences emerged in multivariate analyses. In a multivariate analysis of mephedrone use, the only significant demographic predictor was sexual identity, with heterosexual (odds ratio = 0.38) subjects being significantly less likely to report past year use than GLB subjects (Table 3).

Discussion

Novel psychoactive drugs have received increasing media attention in recent years, though prevalence estimates are scarce. In our sample of adults involved in nightlife scenes, both mephedrone and synthetic cannabinoid use are relatively low in comparison with documented rates of use of other substances in these scenes, which represents a difference from European studies where the use of such drugs, particularly mephedrone, appears more common. Synthetic cannabinoid use is more common than mephedrone use in US nightlife scenes, which is not surprising as marijuana remains the most common illegal drug used and synthetic cannabinoids mimic its effects.

The data indicate that Latino young adults are more likely to use synthetic cannabinoids, though it remains unclear why this may be. Younger subjects were more likely to use synthetic cannabinoids, which could be understood in several ways. First, younger individuals may be more likely to take up these novel substances as they may have less well-defined and stable drug use patterns. In addition, there may be a cohort effect in that younger individuals as a group are more likely to take up these substances. Further, while of relatively low prevalence among young adults involved in nightlife scenes, these substances may be of interest to adolescents more so than young adults, as nightlife scenes have well-established links to existing drug markets. In this regard, the youngest members of the sample may be in the process of aging out of the use of these drugs. Finally, gay and bisexual men were more likely to report mephedrone use than the other groups. Mephedrone has been documented as popular in gay clubs in Europe, which may indicate subcultural trends in the gay community that may more readily circulate between European and the US gay nightlife scenes [10].

Limitations

These data highlight the use of novel psychoactive drugs among adults involved in nightlife scenes, a population previously shown to report high prevalence of substance use. While compelling, some limitations should be considered. The survey, by necessity, was brief, thus limiting the information collected from individuals. Although our survey specified mephedrone, which is considered a ‘bath salt’, studies have identified other substances as ‘bath salts’ [5], and these may also have been considered by some study participants when responding to the survey. Yet we believe our specification of mephedrone may have minimised such responses. Additionally, although subjects self-reported drug use behaviours on a secure device, the public setting may have introduced a social desirability bias. Further, because we sampled from New York City nightlife venues with a time-space sampling method, we may have oversampled people who are more frequent nightlife participants. Yet our use of time-space sampling addresses concerns about generalisability as it provides a systematic approach to sampling this venue-based population. Though our findings do not generalise to all young adults, they strongly represent young people involved in urban nightlife scenes.

Final conclusions

This study fills part of the gap in studies of novel psychoactive substances by examining prevalence among a diverse group of socially active adults in New York. The results indicate that the use of both synthetic cannabinoids and mephedrone among young adults in US nightlife scenes is relatively low compared with the use of other drugs, and in comparison with patterns of use in other regions of the world. Although these novel psychoactive substances have received increased attention in media reports, our data suggest that these substances have not yet made considerable inroads into US nightlife scenes, at least not at the level of that seen in nightlife scenes in other world regions. While further monitoring of these trends is important, excessive alarm within the USA may be unwarranted at this time.

Acknowledgements

This study was supported, in part, by grants from the National Institute on Drug Abuse (R01DA025081) and the National Institute on Child Health & Human Development (R01HD061410). The views expressed in this paper do not expressly reflect the views of the National Institutes of Health or any other governmental agency. The authors acknowledge the contributions of other members of the project team.

Citing Literature

2George Loeffler, Eileen Delaney, Michael Hann, International trends in spice use: Prevalence, motivation for use, relationship to other substances, and perception of use and safety for synthetic cannabinoids, Brain Research Bulletin, 2016CrossRef